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Bizzarri F, Ruiz-Villaverde R, Morales-Garrido P, Ruiz-Carrascosa JC, Cebolla-Verdugo M, Prados-Carmona A, Rodriguez-Troncoso M, Raya-Alvarez E. JAKinhibs in Psoriatic Disease: Analysis of the Efficacy/Safety Profile in Daily Clinical Practice. Diagnostics (Basel) 2024; 14:988. [PMID: 38786286 PMCID: PMC11119658 DOI: 10.3390/diagnostics14100988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/28/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
Psoriatic disease (PsD) affects multiple clinical domains and causes a significant inflammatory burden in patients, requiring comprehensive evaluation and treatment. In recent years, new molecules such as JAK inhibitors (JAKinhibs) have been developed. These have very clear advantages: they act quickly, have a beneficial effect on pain, are well tolerated and the administration route is oral. Despite all this, there is still little scientific evidence in daily clinical practice. This observational, retrospective, single-center study was carried out in patients diagnosed with PsA in the last two years, who started treatment with Tofacitinib or Upadacitinib due to failure of a DMARD. The data of 32 patients were analyzed, and the majority of them (75%) started treatment with Tofacitinib. Most had moderate arthritis activity and mild psoriasis involvement according to activity indices. Both Tofacitinib and Upadacitinib demonstrated significant efficacy, with rapid and statistically significant improvement in joint and skin activity indices, C-reactive protein reduction, and objective measures of disease activity such as the number of painful and inflamed joints. Although there was some difference in the baseline characteristics of the cohort, treatment responses were comparable or even superior to those in the pivotal clinical trials. In addition, there was a low frequency of mild adverse events leading to treatment discontinuation and no serious adverse events. These findings emphasize the strong efficacy and tolerability of JAKinhibs in daily clinical practice, supporting their role as effective therapeutic options for patients with PsD.
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Affiliation(s)
- Francesco Bizzarri
- Servicio de Reumatologia, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (F.B.); (P.M.-G.); (E.R.-A.)
| | - Ricardo Ruiz-Villaverde
- Servicio de Dermatología, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (J.C.R.-C.); (M.C.-V.); (M.R.-T.)
| | - Pilar Morales-Garrido
- Servicio de Reumatologia, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (F.B.); (P.M.-G.); (E.R.-A.)
| | - Jose Carlos Ruiz-Carrascosa
- Servicio de Dermatología, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (J.C.R.-C.); (M.C.-V.); (M.R.-T.)
| | - Marta Cebolla-Verdugo
- Servicio de Dermatología, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (J.C.R.-C.); (M.C.-V.); (M.R.-T.)
| | - Alvaro Prados-Carmona
- Servicio de Dermatología, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (J.C.R.-C.); (M.C.-V.); (M.R.-T.)
| | - Mar Rodriguez-Troncoso
- Servicio de Dermatología, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (J.C.R.-C.); (M.C.-V.); (M.R.-T.)
| | - Enrique Raya-Alvarez
- Servicio de Reumatologia, Instituto Biosanitario de Granada, Ibs, Hospital Universitario San Cecilio, 18012 Granada, Spain; (F.B.); (P.M.-G.); (E.R.-A.)
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Ishchenko A, Pazmino S, Neerinckx B, Lories R, de Vlam K. Comorbidities in Early Psoriatic Arthritis: Data From the Metabolic Disturbances in Psoriatic Arthritis Cohort Study. Arthritis Care Res (Hoboken) 2024; 76:231-240. [PMID: 37667975 DOI: 10.1002/acr.25230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/11/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of comorbidities and cardiovascular (CV) risk factors (RFs) in treatment-naive patients with early psoriatic arthritis (ePsA) and to identify factors that contribute to metabolic burden in ePsA. METHODS This was an observational longitudinal multicenter cohort study. Clinical and demographic characteristics, CV RFs, and comorbidities were compared in patients newly diagnosed with psoriatic arthritis (PsA) and sex- and age-matched controls. In patients with PsA, comorbidities were reevaluated after one year's follow-up because the disease activity changed. RESULTS Sixty-seven patients with ePsA and 61 healthy volunteers were included. The rate of comorbidities was similar in patients with ePsA and in healthy controls; 82.1% of patients with ePsA had CV RFs at baseline as compared with 62.3% of healthy volunteers (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.14-2.0). Patients with ePsA had higher odds of having multiple (two or more) comorbidities (OR 1.9, 95% CI 1.2-3.0) and multiple CV RFs (OR 2.1, 95% CI 1.3-3.2) than the controls. Comorbidities or CV RFs in patients with ePsA were not influenced by duration of skin psoriasis. Dyslipidemia was the most prevalent comorbidity in the PsA cohort (64.2% vs 39.3% in controls; OR 1.7, 95% CI 1.2-2.5). Patients with ePsA had, on average, above normal body mass index (mean ± SD 28.82 ± 4.5) and a higher rate of obesity (40.3% vs 18.3% in controls; OR 1.9, 95% CI 1.1-3.2). After 1 year, although disease activity scores improved, the proportion of patients with comorbidities and CV RFs did not increase or drop. CONCLUSION Our data imply that patients with PsA already have higher comorbidities and CV burden at early stages of the disease, suggesting that these are not only a consequence of long-lasting disease and chronic systemic inflammation.
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Affiliation(s)
- Alla Ishchenko
- Ziekenhuis Netwerk Atwerpen, Antwerp, and University Hospitals Leuven, Leuven, Belgium
| | - Sofia Pazmino
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Barbara Neerinckx
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Rik Lories
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
| | - Kurt de Vlam
- University Hospitals Leuven and Skeletal Biology and Engineering Research Centre, KU Leuven, Leuven, Belgium
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Colaco K, Lee KA, Akhtari S, Winer R, Chandran V, Harvey P, Cook RJ, Piguet V, Gladman DD, Eder L. Derivation and Internal Validation of a Disease-Specific Cardiovascular Risk Prediction Model for Patients With Psoriatic Arthritis and Psoriasis. Arthritis Rheumatol 2024; 76:238-246. [PMID: 37691498 DOI: 10.1002/art.42694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 08/12/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To address suboptimal cardiovascular risk prediction in patients with psoriatic disease (PsD), we developed and internally validated a five-year disease-specific cardiovascular risk prediction model. METHODS We analyzed data from a prospective cohort of participants with PsD without a history of cardiovascular events. Traditional cardiovascular risk factors and PsD-related measures of disease activity were considered as potential predictors. The study outcome included nonfatal and fatal cardiovascular events. A base prediction model included 10 traditional cardiovascular risk factors. Eight PsD-related factors were assessed by adding them to the base model to create expanded models, which were controlled for PsD therapies. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) penalized regression with 10-fold cross-validation. Model performance was assessed using measures of discrimination and calibration and measures of sensitivity and specificity. RESULTS Between 1992 and 2020, 85 of 1,336 participants developed cardiovascular events. Discrimination of the base model (with traditional cardiovascular risk factors alone) was excellent, with an area under the receiver operator characteristic curve (AUC) of 85.5 (95% confidence interval [CI] 81.9-89.1). Optimal models did not select any of the tested disease-specific factors. In a sensitivity analysis, which excluded lipid lowering and antihypertensive treatments, the number of damaged joints was selected in the expanded model. However, this model did not improve risk discrimination compared to the base model (AUC 85.5, 95% CI 82.0-89.1). CONCLUSION Traditional cardiovascular risk factors alone are effective in predicting cardiovascular risk in patients with PsD. A risk score based on these factors performed well, indicating excellent discrimination and calibration.
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Affiliation(s)
- Keith Colaco
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | - Vinod Chandran
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schroeder Arthritis Institute, University Health Network and Depertament of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Vincent Piguet
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Schroeder Arthritis Institute, University Health Network and Depertament of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Womens College Hospital and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Meng H, Cheng IT, Yan BPY, Lee AP, So H, Tam LS. Moderate and high disease activity levels increase the risk of subclinical atherosclerosis progression in early rheumatoid arthritis: a 5-year prospective study. RMD Open 2024; 10:e003488. [PMID: 38199848 PMCID: PMC10806479 DOI: 10.1136/rmdopen-2023-003488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To elucidate the association between different disease activity levels over time on long-term vascular outcomes in patients with early rheumatoid arthritis (ERA). METHODS This was a 5-year prospective study. Patients with consecutive ERA without overt cardiovascular disease (CVD) were recruited to receive 1 year of tight-control treatment followed by standard-of-care management. High-resolution carotid ultrasound was assessed at baseline and year 5. The primary outcome was subclinical atherosclerosis progression (AP+), defined as the occurrence of incident plaque, increased region harbouring plaques and/or maximum carotid intima-media thickness progression ≥0.9 mm at year 5. Inflammatory burden during the follow-up period was represented by the cumulative average Disease Activity Score 28-erythrocyte sedimentation rate (ca-DAS28-ESR). Persistent low disease activity (LDA) or remission state was defined as ca-DAS28-ESR≤3.2. RESULTS One-hundred and four patients with ERA (age: 52±11 years, 81 (77.9%) female) were included in this analysis. Fifty-two (50%) patients achieved persistent LDA or remission and 42 patients (40.4%) had AP+. Patients in the AP+ group were older and had more traditional cardiovascular risk factors at baseline. Multivariate logistic regression analysis revealed that patients with persistent moderate or high disease activity (ca-DAS28-ESR>3.2) had a significantly increased risk of AP+ (OR 5.05, 95% CI 1.53, 16.64, p=0.008) compared with those who achieved persistent remission. The risk of AP+ was similar in patients who achieved persistent LDA and remission. CONCLUSIONS Achieving persistent LDA or remission may prevent progression of atherosclerosis in ERA. A treat-to-target approach aiming at sustained LDA or remission may reduce the risk of CVD by preventing AP+.
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Affiliation(s)
- Huan Meng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Bryan Ping Yen Yan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alex P Lee
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Luciano N, Barone E, Timilsina S, Gershwin ME, Selmi C. Tumor Necrosis Factor Alpha Inhibitors and Cardiovascular Risk in Rheumatoid Arthritis. Clin Rev Allergy Immunol 2023; 65:403-419. [PMID: 38157095 DOI: 10.1007/s12016-023-08975-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by an increased risk of cardiovascular events, due to the complex interplay between traditional and disease-related risk factors. Chronic inflammation and persistent disease activity are the key determinants of this risk, but despite great improvement in the disease management and prognosis, cardiovascular events are still the main cause of morbidity and mortality in RA cohorts1. In the last decades, the advent of new biological and targeted-synthetic DMARDs was accompanied by an improvement in disease activity control, but the role of each class of drugs on CVD risk is still a matter a debate. Since their approval for RA treatment, tumor necrosis factor alpha (TNFα) inhibitors have been widely investigated to better understand their effects on cardiovascular outcomes. The hypothesis that the reduction of chronic inflammation with any treatment may reduce the cardiovascular risk has been recently confuted by the direct comparison of TNFα-inhibitors and JAK inhibitors in patients with RA and coexisting risk factors for cardiovascular disease. The aim of this literature review is to add to the available evidence to analyze the relationship between TNFα-inhibitors and CVD risk in patients with RA and also provide some clinical scenarios to better explain the treatment dilemmas. In particular, while data on major cardiovascular events and thromboembolism seem consistent with an inflammation-mediated benefit with TNFα-inhibitors, there remain concerns about the use of this class of bDMARDs in patients with chronic heart failure.
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Affiliation(s)
- Nicoletta Luciano
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Elisa Barone
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Suraj Timilsina
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California, Davis, USA
| | - Carlo Selmi
- Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
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Schäfer J, Behning C, Brossart P, Bieber T, Wilsmann-Theis D, Schäfer VS. Psoriatic arthritis or osteoarthritis? Data from a specialized dermatological-rheumatological collaboration-the Psoriatic Arthrtis Center Bonn. J Eur Acad Dermatol Venereol 2023; 37:e1348-e1350. [PMID: 37422705 DOI: 10.1111/jdv.19320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Jana Schäfer
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Charlotte Behning
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | | | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
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Pletikosic I, Marasovic Krstulovic D, Bakovic D, Susilovic Grabovac Z, Tandara L, Martinovic Kaliterna D. Association of inflammatory biomarkers and disease activity with subclinical myocardial dysfunction in psoriatic arthritis. Sci Rep 2023; 13:10371. [PMID: 37365233 DOI: 10.1038/s41598-023-37412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/21/2023] [Indexed: 06/28/2023] Open
Abstract
We examined the role of adipokines and pro-inflammatory cytokines in psoriatic arthritis-associated subclinical myocardial dysfunction, and the relationship between these variables and psoriatic arthritis (PsA) disease activity. Fifty-five PsA patients without cardiovascular risk factors and 25 controls underwent standard and speckle tracking echocardiography with global longitudinal strain (GLS) calculated. Standard anthropometric data and Disease Activity in Psoriatic arthritis (DAPSA) scores were recorded, with low disease activity defined as DAPSA ≤ 14 and moderate and high disease activity DAPSA > 14. Standard biochemical tests, adiponectin, resistin, leptin, tumor necrosis factor (TNF) alfa, interleukin 17 A (IL-17A), B lymphocyte chemoattractant (BLC), and monokine induced by intereferon gamma (MIG) were analyzed. Median age was 53.0 (46.0-61.0), median PsA duration 6.0 (4.0-13.0) years and median DAPSA score 25.5 (13.0-41.5). Lower GLS, tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fraction (LVEF) were found in moderate and high PsA disease activity compared to low PsA disease activity and controls. PsA patients with GLS < 20 had higher body mass index (BMI), DAPSA score and uric acid levels, and lower adiponectin levels. Although patients with GLS < 20 had higher IL-17A levels, it was not statistically significant (P = 0.056). However, when we included healthy controls and analyzed differences based on a GLS cut-off of 20% in the entire population, the difference in IL-17A became statistically significant, 0.17 pg/mL (0.06-0.32) vs. 0.43 pg/mL (0.23-0.65), P = 0.017. The association between DAPSA score and GLS and IL-17 remained significant in multivariate analysis. Moreover, the association between GLS and IL-17 and adiponectin was significant after adjustment for age and BMI. Patients with moderate and high PsA disease activity have reduced myocardial function, lower adiponectin, and higher IL-17A levels.
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Affiliation(s)
- Ivan Pletikosic
- Cardiovascular Diseases Department, University Hospital Split, Split, Croatia.
| | | | - Darija Bakovic
- Cardiovascular Diseases Department, University Hospital Split, Split, Croatia
- Department of Physiology, School of Medicine, University of Split, Split, Croatia
| | | | - Leida Tandara
- Medical Laboratory Diagnostic Division, University Hospital of Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
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Prevention and risk assessment of cardiovascular events in a population of patients with psoriasis and psoriatic arthritis. Reumatologia 2022; 60:266-274. [PMID: 36186830 PMCID: PMC9494789 DOI: 10.5114/reum.2022.119043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Psoriasis is a chronic, inflammatory, often relapsing disease that is frequently associated with other diseases of similar pathogenesis. The multi-morbidity in the psoriasis population significantly impedes both diagnosis and implementation of appropriate preventive measures. However, the common denominator for this group of diseases is the inflammatory process that initiates the appearance of subsequent symptoms and health consequences, most of which can be avoided or alleviated by modifying the patient’s lifestyle and incorporating appropriate treatment. Health consequences associated with systemic inflammation include cardiovascular incidents and other cardiometabolic diseases. This article was based on available publications on the onset, incidence, and prevention of cardiovascular disease in the psoriasis patient population.
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Toussirot E, Gallais-Sérézal I, Aubin F. The cardiometabolic conditions of psoriatic disease. Front Immunol 2022; 13:970371. [PMID: 36159785 PMCID: PMC9492868 DOI: 10.3389/fimmu.2022.970371] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Psoriasis (PsO) and psoriatic arthritis (PsA), together known as psoriatic disease (PsD), are immune-mediated diseases with a chronic and relapsing course that affect the skin, the joints or both. The pathophysiology of PsO is complex and involves abnormal expression of keratinocytes and infiltration of the skin with dendritic cells, macrophages, neutrophils and T lymphocytes. Around 30% of patients with PsO develop arthritis with axial and/or peripheral manifestations. Both PsO and PsA share similar Th1- and Th17-driven inflammation, with increased production of inflammatory cytokines, including TNFα, IFN-γ, IL-17, IL-22, IL-23 in the skin and the synovial membrane. PsD is associated with a high burden of cardiometabolic diseases such as hypertension, diabetes, dyslipidemia, obesity, metabolic syndrome and cardiovascular (CV) complications as compared to the general population. These comorbidities share common immunopathogenic pathways linked to systemic inflammation, and are associated with the extent and severity of the disease. Morever, they can influence treatment outcomes in PsD. In this short review, we summarize the available evidence on the epidemiology, clinical aspects and mechanisms of cardiometabolic conditions in patients with PsD. We also discuss the impact of targeted treatments such as methotrexate and biological agents on these cardiometabolic conditions.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, 25000 Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- *Correspondence: Eric Toussirot,
| | - Irène Gallais-Sérézal
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
| | - François Aubin
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université Bourgogne Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
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Zheng Z, Guo Q, Ma D, Wang X, Zhang C, Wang H, Zhang L, Zhang G. Related Risk Factors and Treatment Management of Psoriatic Arthritis Complicated With Cardiovascular Disease. Front Cardiovasc Med 2022; 9:835439. [PMID: 35463753 PMCID: PMC9019598 DOI: 10.3389/fcvm.2022.835439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
Psoriatic arthritis (PsA) is a chronic autoimmune inflammatory joint disease related to psoriasis (PsO). The risk of PsA patients with cardiovascular disease (CVD) is significantly higher than that of the general population. At present, the relevant mechanism is not clear, chronic inflammation and traditional cardiovascular risk factors are the most important factors for the increased risk of CVD in PsA patients. Early assessment of the risk of PsA patients with CVD, and active control of the disease activity of PsA patients and intervention of traditional cardiovascular risk factors can delay the progression of CVD risk. This article reviews the epidemiology and pathogenesis between PsA and CVD, and reviews the latest developments in the risk assessment and management of CVD in PsA patients.
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Affiliation(s)
- Zhoulan Zheng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Qianyu Guo
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Dan Ma
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xuexue Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Chengqiang Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Haiyao Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Liyun Zhang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Gailian Zhang
- The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, China,*Correspondence: Gailian Zhang
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Colaco K, Lee KA, Akhtari S, Winer R, Welsh P, Sattar N, McInnes IB, Chandran V, Harvey P, Cook RJ, Gladman DD, Piguet V, Eder L. Association of Cardiac Biomarkers With Cardiovascular Outcomes in Patients With Psoriatic Arthritis and Psoriasis: A Longitudinal Cohort Study. Arthritis Rheumatol 2022; 74:1184-1192. [PMID: 35261189 PMCID: PMC9545279 DOI: 10.1002/art.42079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/08/2021] [Accepted: 01/25/2022] [Indexed: 11/20/2022]
Abstract
Objective In patients with psoriatic disease (PsD), we determined whether cardiac troponin I (cTnI) and N‐terminal pro–brain natriuretic peptide (NT‐proBNP) were associated with carotid plaque burden and the development of cardiovascular events independent of the Framingham Risk Score (FRS). Methods Among 1,000 patients with PsD, carotid total plaque area (TPA) was measured in 358 participants at baseline. Cardiac troponin I and NT‐proBNP were measured using automated clinical assays. The association between cardiac biomarkers and carotid atherosclerosis was assessed by multivariable regression after adjusting for cardiovascular risk factors. Improvement in the prediction of cardiovascular events beyond the FRS was tested using measures of risk discrimination and reclassification. Results In univariate analyses, cTnI (β coefficient 0.52 [95% confidence interval (95% CI) 0.3, 0.74], P < 0.001) and NT‐proBNP (β coefficient 0.24 [95% CI 0.1, 0.39], P < 0.001) were associated with TPA. After adjusting for cardiovascular risk factors, the association remained statistically significant for cTnI (adjusted β coefficient 0.21 [95% CI 0, 0.41], P = 0.047) but not for NT‐proBNP (P = 0.21). Among the 1,000 patients with PsD assessed for cardiovascular risk prediction, 64 patients had incident cardiovascular events. When comparing a base model (with the FRS alone) to expanded models (with the FRS plus cardiac biomarkers), there was no improvement in predictive performance. Conclusion In patients with PsD, cTnI may reflect the burden of atherosclerosis, independent of traditional cardiovascular risk factors. Cardiac troponin I and NT‐proBNP are associated with incident cardiovascular events independent of the FRS, but further study of their role in cardiovascular risk stratification is warranted.
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Affiliation(s)
- Keith Colaco
- Women's College Hospital, University of Toronto, and University Health Network, Toronto, Ontario, Canada
| | - Ker-Ai Lee
- University of Waterloo, Waterloo, Ontario, Canada
| | - Shadi Akhtari
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Raz Winer
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Vinod Chandran
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Paula Harvey
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Dafna D Gladman
- University of Toronto and University Health Network Toronto, Ontario, Canada
| | - Vincent Piguet
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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Urruticoechea-Arana A, Castañeda S, Otón T, Benavent D, Loza E, Martín-Martínez MA, González-Gay MÁ. Prevalence of Metabolic Syndrome in Psoriatic Arthritis: Systematic Literature Review and Results From the CARMA Cohort. J Clin Rheumatol 2022; 28:e388-e396. [PMID: 35192593 DOI: 10.1097/rhu.0000000000001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the prevalence of metabolic syndrome (MetS) in patients with psoriatic arthritis (PsA) in a systematic literature review (SLR) and in the Spanish CArdiovascular in RheuMAtology (CARMA) cohort. METHODS A SLR and a subanalysis of the CARMA cohort were performed. In the SLR, PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov up to March 2019 were searched. Systematic literature reviews, clinical trials, and observational studies that analyzed the prevalence or frequency of MetS in PsA were analyzed. Two reviewers selected the articles, assessed the quality of the studies, and collected data, independently. In addition, data on sociodemographic characteristics and MetS in patients with PsA from the CARMA cohort were collected and analyzed. Comparative descriptive analysis was performed. RESULTS The SLR included 18 articles, of moderate to high quality, with PsA patients of both sexes, with mean ages between 42 and 59 years. The rate of MetS varied from 23.5% to 62.9%. The most commonly used classification method was that of the National Cholesterol Education Program. Additionally, 724 PsA patients from the CARMA cohort were analyzed; 327 (45.4%) were women, 157 (21.8%) smokers, with a mean age of 51 years and a mean PsA disease duration of 9 years. Hypertension was the most common abnormal finding (66.8%), followed by hyperglycemia (42.6%) and hypertriglyceridemia (30.6%). Notably, 222 patients (30.6%) had MetS. CONCLUSIONS The prevalence of MetS in PsA varies, depending on the definition. Whereas 23.5% to 62.9% of PsA patients have MetS, in the CARMA cohort almost a third of patients with PsA have MetS.
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Affiliation(s)
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, and Cátedra UAM-Roche, EPID-Futuro, Universidad Autónoma de Madrid (UAM)
| | | | - Diego Benavent
- Department of Rheumatology, Hospital Universitario La Paz, IdiPAZ
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Aljohani R. Metabolic Syndrome and Its Components in Psoriatic Arthritis. Open Access Rheumatol 2022; 14:7-16. [PMID: 35210876 PMCID: PMC8860394 DOI: 10.2147/oarrr.s347797] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/05/2022] [Indexed: 11/23/2022] Open
Abstract
Psoriatic arthritis (PsA) is a well-known inflammatory disorder with a wide variety of phenotypes that extend beyond the joints. It has been defined as an immune-mediated disorder in which Th-1 and Th-17 cells play a key role. It has been associated with an elevated risk of metabolic syndrome (MetS), which is characterized by abdominal obesity, hypertension, hyperglycemia, and hyperlipidemia. While the exact pathophysiology of the link between PsA and MetS has yet to be precisely determined, persistence of inflammatory abnormalities, with overexpression of pro-inflammatory cytokines, might be the cause. Studies have consistently emphasized the strong association between elevated risk of developing cardiovascular disease and MetS in individuals with underlying PsA. The literature has also shown an association between the increased PsA severity and the increased frequency of MetS components. This association has important clinical consequences when treating patients with PsA. Therefore, screening programs should be implemented for PsA patients to evaluate whether they have MetS, and appropriate treatment should be given to manage cardiometabolic risk factors. Patients should also be closely monitored for potential adverse treatment effects on co-morbidities. This article summarizes the evidence of associations between several components of MetS and PsA and analyzes the impact of treatment on these factors.
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Affiliation(s)
- Roaa Aljohani
- Department of Medicine, College of Medicine, Taibah University, Madinah, Saudi Arabia
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14
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Cardiovascular risk reclassification according to six cardiovascular risk algorithms and carotid ultrasound in psoriatic arthritis patients. Clin Rheumatol 2021; 41:1413-1420. [PMID: 34826020 DOI: 10.1007/s10067-021-06002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/18/2021] [Accepted: 11/17/2021] [Indexed: 01/16/2023]
Abstract
The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients. KEY POINTS: • Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls. • Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients. • The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI. • All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.
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Atzeni F, Gerratana E, Francesco Masala I, Bongiovanni S, Sarzi-Puttini P, Rodríguez-Carrio J. Psoriatic Arthritis and Metabolic Syndrome: Is There a Role for Disease Modifying Anti-Rheumatic Drugs? Front Med (Lausanne) 2021; 8:735150. [PMID: 34527685 PMCID: PMC8435605 DOI: 10.3389/fmed.2021.735150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
Although psoriatic arthritis (PsA) primarily leads to joint and skin damage, it is associated with higher prevalence of metabolic syndrome (MetS) and its components, namely hypertension, dyslipidemia, obesity, and type II diabetes. Additionally, chronic inflammation is known to aggravate these cardiometabolic factors, thus explaining the enhanced cardiovascular (CV) morbidity and mortality in RA. Furthermore, emerging evidence suggest that some risk factors can fuel inflammation, thus pointing to a bidirectional crosstalk between inflammation and cardiometabolic factors. Therefore, dampening inflammation by disease-modifying anti-rheumatic drugs (DMARDs) may be thought to ameliorate MetS burden and thus, CV risk and disease severity. In fact, recommendations for PsA management emphasize the need of considering comorbidities to guide the treatment decision process. However, the existing evidence on the impact of approved DMARDs in PsA on MetS and MetS components is far from being optimal, thus representing a major challenge for the clinical setting. Although a beneficial effect of some DMARDs such as methotrexate, TNF inhibitors and some small molecules is clear, no head-to-head studies are published and no evidence is available for other therapeutic approaches such as IL-23 or IL-17 inhibitors. This narrative review summarizes the main evidence related to the effect of DMARDs on MetS outcomes in PsA patients and identify the main limitations, research needs and future perspectives in this scenario.
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Affiliation(s)
- Fabiola Atzeni
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy,*Correspondence: Fabiola Atzeni
| | - Elisabetta Gerratana
- Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy
| | | | - Sara Bongiovanni
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Piercarlo Sarzi-Puttini
- Rheumatology Unit, Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli L. Sacco University Hospital, University of Milan, Milan, Italy
| | - Javier Rodríguez-Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain,Area of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Korsakova YL, Korotaeva TV, Loginova EI, Gubar EE, Vasilenko EA, Vasilenko AA, Kuznetsova NA, Patrikeeva IM, Nasonov EL. The relationship between obesity, cardiometabolic disorders and disease activity in psoriatic arthritis patients: data from the Russian register. TERAPEVT ARKH 2021; 93:71511. [DOI: 10.26442/00403660.2021.05.200789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 02/08/2023]
Abstract
Aim. To study the relationship between obesity, cardiometabolic disorders and disease activity in patients with psoriatic arthritis (PsA) in real practice.
Materials and methods. The Russian register included 614 PsA patients [female 331 (54%)/283 (46%)]. Average age 45.20.52 years, PsA duration 5.70.27 years, psoriasis 15.710.56 years. Patients underwent examination, body mass index (BMI), PsA activity according to DAPSA, cDAPSA, analysis of concomitant diseases were assessed. The patients were divided into 3 groups depending on BMI (kg/m2): normal 25 (group 1), increased 2530 (group 2), obesity 30 (group 3).
Results. The average BMI was 27.70.23 kg/m2, normal BMI in 213 (34.7%), increased in 214 (34.8%) and obesity in 187 (30.5%). Concomitant diseases in 297 (48%). In group 3, arterial hypertension was observed significantly more often than in groups 1 and 2 (p0.0001); more often than in group 2 diabetes mellitus (p0.0001), metabolic syndrome (p0.0001); more often than in group 1 ischemic heart disease (p=0.026). PsA activity at Baseline, after 6/12 months was significantly higher in group 3 (p0.031). In obese patients, the chance of a decrease in disease activity to a moderate/low level and remission during therapy for 6/12 months is 2.484 times lower than in group 1, and 2.346 times lower than in group 2: odds ratio 2.346 (95% сonfidence interval 1.075.143) and 2.484 (95% сonfidence interval 1.1355.439), respectively.
Conclusion. In the majority (65.3%) of PsA patients, BMI exceeded the norm. Obesity is associated with a high incidence of cardiometabolic disorders, with higher PsA activity and lower treatment efficacy.
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Khismatullina ZR, Koreshkova KM. The role of endothelial damage and dyslipidemia in the development of cardiovascular pathology in psoriatic arthritis. VESTNIK DERMATOLOGII I VENEROLOGII 2021. [DOI: 10.25208/vdv1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
An increased risk of cardiovascular events has now been identified in patients with psoriatic arthritis. The chronic immune-mediated inflammation underlying psoriatic arthritis (PA) leads to the development of dyslipidemia, atherosclerosis and its complications, in particular, a high risk of cardiovascular complications. For PA, dyslipidemias are most characteristic, manifested by an increased level of low and very low density lipoproteins, triglycerides and total cholesterol, which correlates with the activity of the disease. The literature review studied the pathogenesis of dyslipidemias and vascular wall lesions in psoriatic arthritis, analyzed the literature on cardiovascular complications and mortality among patients with PA, studied the issues of total cardiovascular risk, presented the results of numerous clinical studies that allow PA to be considered a disease associated with increased the risk of cardiovascular complications. Considering the role of proinflammatory cytokines in the pathogenesis of psoriatic arthritis, early detection of endothelial lesions represents the most promising direction in the prevention of cardiovascular diseases, which are the main cause of mortality in this group of patients.
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Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis 2021; 13:1759720X21998279. [PMID: 33737966 PMCID: PMC7934027 DOI: 10.1177/1759720x21998279] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/20/2022] Open
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of cardiometabolic disorders, such as hypertension, dyslipidemia, diabetes, obesity, and cardiovascular disease (CVD), compared with the general population. These comorbidities are associated with the severity of disease, and adversely affect treatment outcomes in PsA. Comorbidities lead to increased physician visits and medications for patients and make the selection and maintenance of therapies challenging for physicians. Moreover, CVD is a leading cause of mortality in PsA. Therefore, optimal management of PsA should include not only treating the skin and joint disease, but also identifying comorbidities early, and managing them to improve long-term outcomes. Further studies are needed to understand the complex mechanisms, interactions, and trajectories of cardiometabolic comorbidities in psoriatic disease.
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Affiliation(s)
| | - Alexis Ogdie
- Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lihi Eder
- Department of Medicine/Rheumatology, Women's College Hospital, University of Toronto, 27 King's College Cir, Toronto, ON M5S, Canada
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19
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Koppikar S, Colaco K, Harvey P, Akhtari S, Chandran V, Gladman DD, Cook R, Eder L. Incidence of and Risk Factors for Heart Failure in Patients with Psoriatic Disease - A Cohort Study. Arthritis Care Res (Hoboken) 2021; 74:1244-1253. [PMID: 33571391 DOI: 10.1002/acr.24578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 12/02/2020] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To assess the incidence and risk factors for heart failure (HF) in patients with psoriatic disease (PsD) and describe their electrocardiographic and echocardiographic findings. METHODS A cohort analysis was conducted involving patients with PsD followed prospectively from 1978 to 2018. Participants were assessed according to a standard protocol every 6 to 12-months. The primary outcome was the time to first event of HF, further classified into ischemic and non-ischemic HF (secondary outcomes). The association between cardiovascular risk factors, measures of disease activity and HF events was assessed using Cox proportional hazards regression. Electrocardiographic and echocardiographic findings associated with HF events were described. RESULTS A total of 1994 patients with PsD were analyzed with 64 incident HF events (38 ischemic, 26 non-ischemic). The incidence rate of first HF event was 2.85 per 1000 patient years. In all events, most common electrocardiographic findings were atrial fibrillation (22%) and bundle branch blocks (29%). Echocardiogram revealed 37% reduced ejection fraction and 63% preserved ejection fraction. In multivariable analysis, independent risk factors for all HF events were ischemic heart disease, adjusted mean (AM)-tender joint count, AM-swollen joint count, AM-erythrocyte sedimentation rate, AM-C-reactive protein, and physical function (by health assessment questionnaire) (all p<0.05). Minimal disease activity state was protective for all HF (p<0.05). CONCLUSIONS Increased risk of HF is associated with a combination of known cardiovascular risk factors and measures of disease activity, particularly in non-ischemic HF. The effect of inflammation on HF may be partially independent of atherosclerotic disease.
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Affiliation(s)
- Sahil Koppikar
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Keith Colaco
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada
| | - Paula Harvey
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Women's College Hospital, Toronto, ON, Canada
| | - Shadi Akhtari
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Cardiology, Women's College Hospital, Toronto, ON, Canada
| | - Vinod Chandran
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | | | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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20
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Cintron BJ. Psoriatic Arthritis. PHYSICIAN ASSISTANT CLINICS 2021. [DOI: 10.1016/j.cpha.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Kenney-Riley K, Berkowitz SS, Rapoza K. Understanding patient-provider discordance in adolescents with lupus: The role of pain and antidepressant medication use. Health Psychol Open 2020; 7:2055102920977714. [PMID: 33343916 PMCID: PMC7727063 DOI: 10.1177/2055102920977714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The current study examines depression and pain as potential contributors to patient-provider discordance in the assessment of lupus disease activity. The study conducted a secondary analysis of data obtained from the Childhood Arthritis and Rheumatology Research Alliance registry, with N = 859 adolescent participants. Assessments of pain, disease activity, and antidepressant medication use were collected from the patient and provider. Results indicated that depression might be underdiagnosed in pediatric lupus patients. While psychotropic medication and pain scores were independently related to greater patient-provider discordance regarding health status, pain mediated this relationship. Implications for treatment outcomes are discussed.
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22
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Papagoras C, Voulgari PV, Drosos AA. Cardiovascular Disease in Spondyloarthritides. Curr Vasc Pharmacol 2020; 18:473-487. [PMID: 31330576 DOI: 10.2174/1570161117666190426164306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 12/15/2022]
Abstract
The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians' attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.
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Affiliation(s)
- Charalampos Papagoras
- 1st Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Alexandros A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Cheng IT, Li EK, Wong PC, Law MY, Yim IC, Lai BT, Ying SK, Kwok KY, Li M, Li TK, Lee JJ, Szeto CC, Yan BP, Lee AP, Tam LS. Treat to target and prevention of subclinical atherosclerosis in psoriatic arthritis-which target should we choose? Rheumatology (Oxford) 2020; 59:2881-2892. [PMID: 32087023 DOI: 10.1093/rheumatology/keaa025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/10/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE PsA patients who achieved sustained minimal disease activity (sMDA) had less subclinical atherosclerosis progression. The vascular effects of achieving other potential treatment targets, including the PsA Disease Activity Score (PASDAS) and the Disease Activity in PsA (DAPSA) score, remained uncertain. This study aimed to compare the vascular effects of achieving different treatment targets in PsA patients. METHOD This is a post hoc analysis of a 2 year treat-to-target study aimed at MDA. A total of 101 consecutive PsA patients without overt cardiovascular disease were recruited. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. Low disease activity (LDA) was defined as MDA, DAPSA ≤14 or PASDAS ≤3.2. Sustained disease control was defined as achieving these targets at each visit from month 12 until month 24. RESULTS Ninety patients [52 male (57.8%), age 50 years (s.d. 11)] who completed 24 months of follow-up were included in this analysis. A total of 44%, 48% and 45% of patients achieved sustained DAPSA LDA (sDAPDA-LDA), sustained PASDAS LDA (sPASDAS-LDA) and sMDA, respectively. Patients who achieved sMDA had significantly less progression of carotid intima-media thickness than those who did not (P = 0.031). Using multivariate analysis, achieving sMDA and sPASDAS-LDA had a protective effect on plaque progression, less increase in total plaque area, reduced mean intima-media thickness and reduced augmentation index after adjusting for covariates. In contrast, no significant differences in the progression of vascular parameters were demonstrated between patients who did or did not achieve sDAPSA-LDA. CONCLUSION Achieving sMDA/sDASPAS-LDA, but not sDAPSA-LDA, was associated with a protective effect in subclinical atherosclerosis and arterial stiffness progression. A multidimensional domain of disease control might be better in minimizing cardiovascular risk in PsA.
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Affiliation(s)
- Isaac T Cheng
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla C Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Mei Yan Law
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Isaac C Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Billy T Lai
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong
| | - Shirley K Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Kitty Y Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong
| | - Martin Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- Division of Biostatistics, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex P Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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da Cruz Ribeiro E Souza E, da Silva Carneiro SC, Yazbek MA, de Cássia Menin R, Campanholo CB, Carneiro JN, da Silva CHM, Ranza R. Validation and clinical interpretability of PsAID - psoriatic arthritis impact of disease. Adv Rheumatol 2020; 60:49. [PMID: 32962756 DOI: 10.1186/s42358-020-00149-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a chronic inflammatory disease of widely varying presentation, which determines functional and psychological impairment, with a high negative impact on patients' quality of life. Therefore, knowing the patient's perception of their health status is of fundamental importance for understanding the real impact of PsA. Given this context, the European League Against Rheumatism (EULAR) recently developed the Psoriatic Arthritis Impact of Disease (PsAID) - instrument to specifically assess the impact of PsA for the patient. OBJECTIVE Validate the brazilian portuguese version of PsAID-12 (Psoriatic Arthritis Impact of Disease) and to verify its interpretability in clinical practice, through its relation with measures of psoriatic arthritis activity. METHODS A multicenter cross-sectional study, which recruited 160 patients, who met the Classification criteria for Psoriatic Arthritis (CASPAR), in six Brazilian centers of rheumatology. Reliability was assessed by Cronbach's alpha coefficient and by the intraclass correlation coefficient (ICC). The construct validity was evaluated by exploratory factorial analysis and also by Spearman correlation with other PROMs and measures of disease activity evaluation. RESULTS Of the total number of participants, 50% were female, with a mean age (SD) of 54.0 ± 11.2 years; 68% had only peripheral arthritis and 32% had pure or mixed axial involvement. The majority (67.7%) of the patients were using biological treatment. The reliability of internal consistency (alpha-Cronbach = 0.93) and test-retest (ICC = 0.996) were good. Factor analysis revealed two factors, named physical and psychosocial, which included the skin evaluation item. PsAID-12 correlated significantly with other PROMs, demonstrating good construct validity. PsAID-12 was also significantly associated with the disease activity assessment instruments (DAS28-ESR, ASDAS, and BASDAI) and the MDA status: "Minimum Disease Activity". Fibromyalgia did not significantly affect the final PsAID-12 score. CONCLUSION The brazilian version of PsAID-12 has been shown to be a reliable and valid measure of the impact of the disease in patients with psoriatic arthritis. Moreover, it associated significantly with the scores of disease activity assessment.
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Affiliation(s)
- Elziane da Cruz Ribeiro E Souza
- Department of Rheumatology, Federal University of Uberlândia, Av. Mato Grosso, 3395, 302, Umuarama, Uberlândia, Minas Gerais, 38405-314, Brazil.
| | | | | | - Rita de Cássia Menin
- Faculty of Medicine of São José do Rio Preto, São Paulo, São José do Rio Preto, Brazil
| | | | | | - Carlos Henrique Martis da Silva
- Department of Rheumatology, Federal University of Uberlândia, Av. Mato Grosso, 3395, 302, Umuarama, Uberlândia, Minas Gerais, 38405-314, Brazil
| | - Roberto Ranza
- Department of Rheumatology, Federal University of Uberlândia, Av. Mato Grosso, 3395, 302, Umuarama, Uberlândia, Minas Gerais, 38405-314, Brazil
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Mendonça JA, Pansani LN, Mimoto MB, Ferreira ITG, Sanches FB, de Campos Ferreira Pinto T, Leandro-Merhi VA, de Aquino JLB. Nail enthesis ultrasound and automated software-guided assessment of bilateral common carotid intima-media thickness in psoriasis and psoriatic arthritis: is there a correlation with clinical and laboratory findings? Drugs Context 2020; 9:2020-1-2. [PMID: 32547626 PMCID: PMC7271708 DOI: 10.7573/dic.2020-1-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Ultrasound (US) in psoriasis (PsO) and psoriatic arthritis (PsA) is an important tool in several situations to detect joint ecostructural damage as well as other tissue alterations, such as those that occur in the larger vessels. The objective of this study was to detect and correlate the changes that indicate the inflammatory and atherosclerotic process in two groups of patients, using nail US and carotid artery intima-media thickness radiofrequency (RF) software. METHODS A total of 30 patients diagnosed with (PsO) and (PsA) were selected. About 15 patients were present in each group, assigned by the Dermatology and Rheumatology Service of the Universidade Pontifícia Católica de Campinas, São Paulo, Brazil, and were assessed using carotid artery US (radiofrequency quality intima-media thickness [RF-QIMT]), joint US, clinical evaluation, and laboratory tests. RESULTS Spearman and Pearson correlations between US variables per group were Psoriasis Area and Severity Index (PASI) and loss of the nail pattern trilaminar: r=0.658, p=0.015; Framingham Score (FS) and Internal Resistance Index (IR): 0.351 to 0.526, p=0.034 to 0.002; the significant correlations by the Bayesian factor (BF) were those with a BF greater than 2.5, between QIMT expected with FS: r=0.677, BF=10.06, with total cholesterol: r=0.5232, BF=2.60, and QIMT-RF with low density lipoproteins: r=0.633, BF=3.70. CONCLUSION The use of US in the evaluation of these patients showed significant correlations between clinical and laboratory measures, characterized by QIMT and FS as well as changes in nail insertion. Future studies may demonstrate an even better interaction.
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Affiliation(s)
- José Alexandre Mendonça
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - Lucas Nogueira Pansani
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Mateus Basso Mimoto
- Serviço de Reumatologia, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | | | | | | | - Vania Aparecida Leandro-Merhi
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
| | - José Luis Braga de Aquino
- Health Sciences Post-Graduation Program, PUC-Campinas – SP-Brazil Research Group: Diagnostics and Clinical and Surgical Therapy, São Paulo, Brazil
- Serviço de Clínica Cirúrgica e Pós Graduação da Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
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Martínez-Vidal MP, Andrés M, Jovaní V, Santos-Ramírez C, Romera C, Fernández-Carballido C. Role of Carotid Ultrasound and Systematic Coronary Risk Evaluation Charts for the Cardiovascular Risk Stratification of Patients with Psoriatic Arthritis. J Rheumatol 2020; 47:682-689. [PMID: 31203214 DOI: 10.3899/jrheum.181223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The assessment of the cardiovascular (CV) risk is recommended in patients with chronic inflammatory rheumatic diseases. The objectives of this study were to assess the CV risk profile in a cohort of patients with psoriatic arthritis (PsA), to determine the presence of subclinical cardiovascular disease by carotid ultrasound (US), and to study the association of CV disease to PsA characteristics. METHODS This was a cross-sectional multicentric descriptive study. The clinical CV risk was calculated with Systematic Coronary Risk Evaluation (SCORE) charts. Common carotid US was conducted to evaluate the carotid wall intima-media thickness and the presence of atheroma plaques. Patients were reclassified upon US results. Multivariate analyses were performed to identify associations of US carotid abnormalities with the classical CV risk factors and PsA characteristics. RESULTS The study included 176 patients with PsA. The SCORE-estimated CV risk was intermediate in 65.3% of the patients. In the US study, 32% of the patients had abnormalities, and 30.8% of the patients were upgraded and reclassified as very high risk owing to the presence of atheroma. Subclinical CV disease was associated with age and dyslipidemia but not with other risk factors. It was associated with axial disease in the subgroup with intermediate risk, and with C-reactive protein levels in patients with high risk. CONCLUSION Many patients with PsA have clinical estimated intermediate or high risk of a fatal CV event. A carotid US study detects subclinical vascular disease and may be useful to depict the real risk. The presence of atheroma is only partially explained by the classic CV risk factors.
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Affiliation(s)
- María Paz Martínez-Vidal
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain. .,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan.
| | - Mariano Andrés
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Vega Jovaní
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Carlos Santos-Ramírez
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Cintia Romera
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
| | - Cristina Fernández-Carballido
- From the Hospital General Universitario de Alicante, Alicante; Hospital Virgen de los Lirios, Alcoy; Hospital del Vinalopó, Elche; and Hospital General Universitario de San Juan, Alicante, Spain.,M.P. Martínez-Vidal, MD, PhD, Hospital General Universitario de Alicante; M. Andrés, MD, PhD, Hospital General Universitario de Alicante; V. Jovaní, MD, Hospital General Universitario de Alicante; C. Santos-Ramírez, MD, Hospital Virgen de los Lirios; C. Romera, MD, PhD, Hospital del Vinalopó; C. Fernández-Carballido, MD, PhD, Hospital General Universitario de San Juan
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Caso F, Chimenti MS, Navarini L, Ruscitti P, Peluso R, Girolimetto N, Del Puente A, Giacomelli R, Scarpa R, Costa L. Metabolic Syndrome and psoriatic arthritis: considerations for the clinician. Expert Rev Clin Immunol 2020; 16:409-420. [PMID: 32149545 DOI: 10.1080/1744666x.2020.1740593] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Metabolic Syndrome (MetS) is strictly interconnected with systemic inflammation, and increased evidence has described a close link between this condition and Psoriatic Arthritis (PsA).Areas covered: This review summarizes main studies exploring clinical aspects and prevalence of MetS in PsA cohorts. Further, there is accumulating evidence showing shared inflammatory pathways between MetS, its components, and PsA.Expert opinion: The high prevalence of MetS in PsA highlights the need for screening, evaluation, and close monitoring of MetS and its components (namely, diabetes mellitus, obesity, hypertension, and dyslipidemia) in psoriatic patients.Further studies should focus on the pathogenetic link between MetS and PsA. More studies are required to identify appropriate algorithms for the assessment and management of MetS in PsA patients.
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Affiliation(s)
- Francesco Caso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Luca Navarini
- Unit of Allergology, Clinical Immunology and Rheumatology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rosario Peluso
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Nicolò Girolimetto
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.,Department of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Del Puente
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Roberto Giacomelli
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Lo Gullo A, Rodríguez-Carrio J, Gallizzi R, Imbalzano E, Squadrito G, Mandraffino G. Speckle tracking echocardiography as a new diagnostic tool for an assessment of cardiovascular disease in rheumatic patients. Prog Cardiovasc Dis 2020; 63:327-340. [PMID: 32201285 DOI: 10.1016/j.pcad.2020.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/08/2020] [Indexed: 12/30/2022]
Abstract
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.
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Affiliation(s)
- Alberto Lo Gullo
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy; IRCCS Neurolesi Bonino-Pulejo, Piemonte Hospital, 98100, Italy
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Faculty of Medicine, University of Oviedo, Oviedo 33006, Spain; Instituto de Investigación Sanitaria Del Principado de Asturias (ISPA), Oviedo 33011, Spain; Bone and Mineral Research Unit, Instituto Reina Sofía de Investigación Nefrológica, REDinREN Del ISCIII, Hospital Universitario Central de Asturias, Oviedo 33011, Spain.
| | - Romina Gallizzi
- Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood, University of Messina, 98122
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giovanni Squadrito
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
| | - Giuseppe Mandraffino
- Department of Clinical and Experimental Medicine, Internal Medicine Unit, 98122, Italy
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Szentpetery A, Haroon M, FitzGerald O. Cardiovascular Comorbidities in Psoriatic Disease. Rheumatol Ther 2020; 7:5-17. [PMID: 31813119 PMCID: PMC7021890 DOI: 10.1007/s40744-019-00185-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 02/06/2023] Open
Abstract
Psoriatic disease (PsD) is a multisystem inflammatory disorder with a high prevalence of cardiovascular (CV) risk factors contributing to accelerated atherosclerosis and its sequelae. Imaging studies, notably with ultrasound, computed tomography, and positron emission tomography (PET) scanning have confirmed significant atherosclerotic change with plaque formation and vessel stenosis. Atherosclerosis is likely driven by a combination of traditional risk factors which occur more frequently in PsD and by systemic inflammation with associated pro-inflammatory cytokine production. While the mechanisms driving atherosclerosis in PsD are incompletely understood, it is now best practice to try to minimize the impact of CV risk factors by regular assessment, prevention, and treatment and also by ensuring that inflammatory musculoskeletal and cutaneous disease is adequately suppressed. Future studies need to focus on improving our understanding of the mechanisms driving atherosclerosis and, as a consequence, developing more rationale approaches to prevention and treatment.
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Affiliation(s)
- Agnes Szentpetery
- Department of Rheumatology, Uppsala University Hospital, Uppsala, Sweden
| | - Muhammad Haroon
- Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland.
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30
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Palmou-Fontana N, Martínez-Lopez D, Corrales A, Rueda-Gotor J, Genre F, Armesto S, González-López MA, Quevedo-Abeledo JC, Portilla-González V, Blanco R, Hernandez JL, Llorca J, González-Gay MÁ, Ferraz-Amaro I. Disease Activity Influences Cardiovascular Risk Reclassification Based on Carotid Ultrasound in Patients with Psoriatic Arthritis. J Rheumatol 2019; 47:1344-1353. [PMID: 31732555 DOI: 10.3899/jrheum.190729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Because the addition of carotid ultrasound (US) into composite cardiovascular (CV) risk scores has been found effective for identifying patients with inflammatory arthritis and high CV risk, we aimed to determine whether its use would facilitate the reclassification of patients with psoriatic arthritis (PsA) into the very high Systematic Coronary Risk Evaluation (SCORE) risk category and whether this might be related to disease features. METHODS This was a cross-sectional study involving 206 patients who fulfilled ClASsification for Psoriatic ARthritis criteria for PsA, and 179 controls. We assessed lipid profile, SCORE, disease activity measurements, and the presence of carotid plaques and carotid intima-media thickness by ultrasonography. A multivariable regression analysis, adjusted for classic CV risk factors, was performed to evaluate whether the risk of reclassification could be explained by disease-related features and to assess the most parsimonious combination of risk reclassification predictors. RESULTS Forty-seven percent of patients were reclassified into a very high SCORE risk category after carotid US compared to 26% of controls (p < 0.001). Patients included in the low SCORE risk category were those who were more commonly reclassified (30% vs 14%, p = 0.002). The Disease Activity Index for PsA (DAPSA) score was associated with reclassification (β 1.10, 95% CI 1.02-1.19; p = 0.019) after adjusting for age and traditional CV risk factors. A model containing SCORE plus age, statin use, and DAPSA score yielded the highest discriminatory accuracy compared to the SCORE-alone model (area under the receiver-operating characteristic curve 0.863, 95% CI 0.789-0.936 vs 0.716, 95% CI 0.668-0.764; p < 0.001). CONCLUSION Patients with PsA are more frequently reclassified into the very high SCORE risk category following carotid US assessment than controls. This was independently explained by the disease activity.
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Affiliation(s)
- Natalia Palmou-Fontana
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - David Martínez-Lopez
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Alfonso Corrales
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Javier Rueda-Gotor
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Fernanda Genre
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Susana Armesto
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Marcos A González-López
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Juan C Quevedo-Abeledo
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Virginia Portilla-González
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Ricardo Blanco
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - José L Hernandez
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Javier Llorca
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Miguel Á González-Gay
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship
| | - Iván Ferraz-Amaro
- From the Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander; Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Gran Canaria; University of Cantabria, IDIVAL, Santander; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid; School of Medicine, University of Cantabria, Santander; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,N. Palmou-Fontana, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; D. Martínez-López, MD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; A. Corrales, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Rueda-Gotor, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; F. Genre, PhD, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; S. Armesto, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; M.A. González-López, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; V. Portilla-González, BSc, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; R. Blanco, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J.L. Hernández, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; J. Llorca, MD, PhD, University of Cantabria, IDIVAL, and CIBERESP, and School of Medicine, University of Cantabria; M.A. González-Gay, MD, PhD, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias. Drs. M.A. González-Gay and I. Ferraz-Amaro share senior authorship.
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Landgren AJ, Bilberg A, Eliasson B, Larsson I, Dehlin M, Jacobsson LTH, Klingberg E. Cardiovascular risk factors are highly overrepresented in Swedish patients with psoriatic arthritis compared with the general population. Scand J Rheumatol 2019; 49:195-199. [DOI: 10.1080/03009742.2019.1672783] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- AJ Landgren
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - I Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Dehlin
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - LTH Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Sobchak C, Akhtari S, Harvey P, Gladman D, Chandran V, Cook R, Eder L. Value of Carotid Ultrasound in Cardiovascular Risk Stratification in Patients With Psoriatic Disease. Arthritis Rheumatol 2019; 71:1651-1659. [PMID: 31165591 DOI: 10.1002/art.40925] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 05/07/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study aimed to assess whether subclinical atherosclerosis, as evaluated by carotid ultrasound, could predict incident cardiovascular events (CVEs) in patients with psoriatic disease (PsD) and determine whether incorporation of imaging data could improve CV risk prediction by the Framingham Risk Score (FRS). METHODS In this cohort analysis, patients with PsD underwent ultrasound assessment of the carotid arteries at baseline. The extent of atherosclerosis was assessed using carotid intima-media thickness (CIMT) and total plaque area (TPA). Incident CVEs (new or recurrent) that occurred following the ultrasound assessment were identified. The association between measures of carotid atherosclerosis and the risk of developing an incident CVE was evaluated using Cox proportional hazards models, with adjustment for the FRS. RESULTS In total, 559 patients with PsD were assessed, of whom 23 had incident CVEs ascertained. The calculated rate of developing a first CVE during the study period was 1.11 events per 100 patient-years (95% confidence interval [95% CI] 0.74-1.67). When analyzed separately in Cox proportional hazards models that were controlled for the FRS, the TPA (hazard ratio [HR] 3.74, 95% CI 1.55-8.85; P = 0.003), mean CIMT (HR 1.21, 95% CI 1.03-1.42; P = 0.02), maximal CIMT (HR 1.11, 95% CI 1.01-1.22; P = 0.03), and high TPA category (HR 3.25, 95% CI 1.18-8.95; P = 0.02) were each predictive of incident CVEs in patients with PsD. CONCLUSION The burden of carotid atherosclerosis is associated with an increased risk of developing future CVEs. Combining vascular imaging data with information on traditional CV risk factors could improve the accuracy of CV risk stratification in patients with PsD.
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Affiliation(s)
| | | | - Paula Harvey
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Dafna Gladman
- University of Toronto, Krembil Research Institute and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vinod Chandran
- University of Toronto, Krembil Research Institute and Toronto Western Hospital, Toronto, Ontario, Canada
| | - Richard Cook
- University of Waterloo, Waterloo, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital and University of Toronto, Toronto, Ontario, Canada
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Colaco K, Ocampo V, Ayala AP, Harvey P, Gladman DD, Piguet V, Eder L. Predictive Utility of Cardiovascular Risk Prediction Algorithms in Inflammatory Rheumatic Diseases: A Systematic Review. J Rheumatol 2019; 47:928-938. [DOI: 10.3899/jrheum.190261] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/04/2023]
Abstract
Objective.We performed a systematic review of the literature to describe current knowledge of cardiovascular (CV) risk prediction algorithms in rheumatic diseases.Methods.A systematic search of MEDLINE, EMBASE, and Cochrane Central databases was performed. The search was restricted to original publications in English, had to include clinical CV events as study outcomes, assess the predictive properties of at least 1 CV risk prediction algorithm, and include patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), or psoriasis. By design, only cohort studies that followed participants for CV events were selected.Results.Eleven of 146 identified manuscripts were included. Studies evaluated the predictive performance of the Framingham Risk Score, QRISK2, Systematic Coronary Risk Evaluation (SCORE), Reynolds Risk Score, American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE), Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), and the Italian Progetto CUORE score. Approaches to improve predictive performance of general risk algorithms in patients with RA included the use of multipliers, biomarkers, disease-specific variables, or a combination of these to modify or develop an algorithm. In both SLE and PsA patients, multipliers were applied to general risk algorithms. In studies of RA and SLE patients, efforts to include nontraditional risk factors, disease-related variables, multipliers, and biomarkers largely failed to substantially improve risk estimates.Conclusion.Our study confirmed that general risk algorithms mostly underestimate and at times overestimate CV risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations.
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Klingberg E, Bilberg A, Björkman S, Hedberg M, Jacobsson L, Forsblad-d'Elia H, Carlsten H, Eliasson B, Larsson I. Weight loss improves disease activity in patients with psoriatic arthritis and obesity: an interventional study. Arthritis Res Ther 2019; 21:17. [PMID: 30635024 PMCID: PMC6330463 DOI: 10.1186/s13075-019-1810-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022] Open
Abstract
Background Obesity is over-represented in patients with psoriatic arthritis (PsA) and associated with higher disease activity, poorer effect of treatment and increased cardiovascular morbidity. Studies on the effects of weight loss are however needed. This study aimed to prospectively study the effects of weight loss treatment with very low energy diet (VLED) on disease activity in patients with PsA (CASPAR criteria) and obesity (body mass index BMI ≥ 33 kg/m2). Methods VLED (640 kcal/day) was taken during 12–16 weeks, depending on pre-treatment BMI. Afterwards, an energy-restricted diet was gradually reintroduced. Weight loss treatment was given within a structured framework for support and medical follow-up. Treatment with conventional synthetic and/or biologic disease-modifying anti-rheumatic drugs was held constant from 3 months before, until 6 months after baseline. Patients were assessed with BMI, 66/68 joints count, Leeds enthesitis index, psoriasis body surface area (BSA), questionnaires and CRP at baseline, 3 and 6 months. Primary outcome was the percentage of patients reaching minimal disease activity (MDA) and secondary outcomes were reaching Psoriatic Arthritis Response Criteria (PsARC) and American College of Rheumatology (ACR) response criteria. Results Totally 41/46 patients completed the study, 63% women, median age 54 years (IQR 48–62). At baseline increased BMI was associated with higher disease activity and poorer function. The median weight loss was 18.7 kg (IQR 14.6–26.5) or 18.6% (IQR 14.7–26.3) of the baseline weight. A majority of the disease activity parameters improved significantly after weight loss, including 68/66 tender/swollen joints count, CRP, BSA, Leeds enthesitis index, HAQ and patient VAS for global health, pain and fatigue. A larger weight loss resulted in more improvement in a dose-response manner. The percentage of patients with MDA increased from 29 to 54%, (p = 0.002). PsARC was reached by 46.3%. The ACR 20, 50 and 70 responses were 51.2%, 34.1% and 7.3% respectively. Conclusions Short-term weight loss treatment with VLED was associated with significant positive effects on disease activity in joints, entheses and skin in patients with PsA and obesity. The study supports the hypothesis of obesity as a promotor of disease activity in PsA. Trial registration ClinicalTrials.gov identifier: NCT02917434, registered on September 21, 2016—retrospectively registered Electronic supplementary material The online version of this article (10.1186/s13075-019-1810-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - Annelie Bilberg
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sofia Björkman
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Martin Hedberg
- Department of Rheumatology, Hospital of Borås, Borås, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Helena Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
| | - Hans Carlsten
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ingrid Larsson
- Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Cheng IT, Shang Q, Li EK, Wong PC, Kun EW, Law MY, Yip RM, Yim IC, Lai BT, Ying SK, Kwok KY, Li M, Li TK, Zhu TY, Lee JJ, Chang MM, Szeto CC, Yan BP, Lee AP, Tam LS. Effect of Achieving Minimal Disease Activity on the Progression of Subclinical Atherosclerosis and Arterial Stiffness: A Prospective Cohort Study in Psoriatic Arthritis. Arthritis Rheumatol 2019; 71:271-280. [PMID: 30144299 DOI: 10.1002/art.40695] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/21/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the effects of achieving minimal disease activity (MDA) on the progression of subclinical atherosclerosis and arterial stiffness in patients with psoriatic arthritis (PsA). METHODS A total of 101 consecutive patients with PsA were recruited for this prospective cohort study. All patients received protocolized treatment targeting MDA for a period of 2 years. High-resolution carotid ultrasound and arterial stiffness markers were assessed annually. The primary outcome measure was the effect of achieving MDA at 12 months (MDA group) on the progression of subclinical atherosclerosis over a period of 24 months. Secondary objectives were to compare the changes in arterial stiffness markers over 24 months between the MDA and non-MDA groups, as well as the changes in subclinical atherosclerosis and arterial stiffness markers in patients who achieved MDA at each visit from month 12 through month 24 (sustained MDA [sMDA]). RESULTS Ninety PsA patients (mean ± SD age 50 ± 11 years, 58% male [n = 52]) who completed 24 months of follow-up were included in this analysis. Fifty-seven patients (63%) had achieved MDA at 12 months. Subclinical atherosclerosis and arterial stiffness outcomes were similar between the MDA and non-MDA groups. Forty-one patients (46%) achieved sMDA. As shown by multivariate analysis, achieving sMDA had a protective effect on plaque progression (odds ratio 0.273 [95% confidence interval 0.088-0.846], P = 0.024), and less of an increase in total plaque area, mean intima-media thickness, and augmentation index values after adjustment for covariates. CONCLUSION Our results support the recommendation that once MDA is achieved, it should ideally be maintained for a prolonged period in order to prevent progression of carotid atherosclerosis and arterial stiffness in patients with PsA.
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Affiliation(s)
- Isaac T Cheng
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Qing Shang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla C Wong
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - Mei Yan Law
- Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | | | | | | | | | | | - Martin Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tracy Y Zhu
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jack J Lee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Mimi M Chang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Bryan P Yan
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex P Lee
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Elmamoun M, Leung YY, O'Sullivan D, Steinkoenig I, Chandran V, Gladman DD, FitzGerald OM, Orbai AM, Eder L. Using Acute-phase Reactants to Inform the Development of Instruments for the Updated Psoriatic Arthritis Core Outcome Measurement Set. J Rheumatol 2018; 46:266-273. [PMID: 30385708 DOI: 10.3899/jrheum.180195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Systemic inflammationˆ is assessed through measurement of acute-phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). With few exceptions, most randomized controlled trials (RCT) have assessed acute-phase reactants (CRP and ESR) as part of the American College of Rheumatology (ACR) 20 response criteria. As part of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) working group, we performed a systematic review of the literature to assess the performance of inflammatory biomarkers in psoriatic arthritis (PsA). METHODS A systematic search of PubMed and Embase was performed. The search included peer-reviewed articles and scientific meeting abstracts about RCT and longitudinal observational studies that assessed systemic inflammation using acute-phase reactants in PsA. Studies were assessed following the components of the OMERACT filter including construct validity, responsiveness, and predictive validity. RESULTS There were 2764 articles retrieved, and 71 articles were included for this systematic review. Twenty-eight articles reported CRP and/or ESR separately, and the remaining articles reported CRP and/or ESR as part of the ACR response criteria. Studies assessing OMERACT responsiveness provided conflicting reports. Inflammatory biomarkers had construct validity for more active disease. Evidence suggests that an elevation of ESR predicts cardiovascular outcomes. CONCLUSION Data regarding assessment of systemic inflammation using acute-phase reactants (CRP and ESR) are limited. There is only weak evidence to support normalization of these biomarkers in predicting good clinical outcomes/remission criteria. The predictive value for cardiovascular outcomes was generally good. Further studies to assess systemic inflammation in PsA using acute-phase reactants and other laboratory biomarkers are needed.
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Affiliation(s)
- Musaab Elmamoun
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ying Ying Leung
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Denis O'Sullivan
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ingrid Steinkoenig
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Vinod Chandran
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Dafna D Gladman
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Oliver M FitzGerald
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Ana-Maria Orbai
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto
| | - Lihi Eder
- From the Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Rheumatology and Immunology, Singapore General Hospital; Duke-NUS Medical School, Singapore; University Hospitals, Cleveland, Ohio, USA; Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; Johns Hopkins University School of Medicine, Division of Rheumatology, Baltimore, Maryland, USA; Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. .,M. Elmamoun, MBBS, MRCPI, Department of Rheumatology, St. Vincent's University Hospital, and Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; Y.Y. Leung, MBChB, MD, Department of Rheumatology and Immunology, Singapore General Hospital, and Duke-NUS Medical School; D. O'Sullivan, BE, Patient Research Partner, St. Vincent's University Hospital; I. Steinkoenig, BA, Patient Research Partner, University Hospitals; V. Chandran, MBBS, MD, DM, PhD, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Division of Rheumatology, University of Toronto, Krembil Research Institute, Toronto Western Hospital; O.M. FitzGerald, MD, Department of Rheumatology, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin; A.M. Orbai, MD, MHS, Johns Hopkins University School of Medicine, Division of Rheumatology; L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto.
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Chiu HY, Chang WL, Shiu MN, Huang WF, Tsai TF. Psoriasis is associated with a greater risk for cardiovascular procedure and surgery in patients with hypertension: A nationwide cohort study. J Dermatol 2018; 45:1381-1388. [PMID: 30328149 DOI: 10.1111/1346-8138.14654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/15/2018] [Indexed: 01/04/2023]
Abstract
Psoriasis increases the incidence of hypertension and cardiovascular disease. However, its effect on the course of cardiovascular disease remains unknown. To investigate whether patients with psoriasis and hypertension have a higher requirement for cardiovascular procedure and surgery than patients with hypertension but without psoriasis, we used the Taiwan National Health Insurance Research Database to identify patients with new-onset hypertension during 2005-2006. Among these patients, those with psoriasis (n = 4039) were matched in a 1:1 ratio by age and sex with patients without psoriasis. The association between psoriasis and cardiovascular interventions was examined using time-varying Cox proportional hazards models. The mean follow-up period was 5.62 years. Psoriasis was associated with an increased risk for cardiovascular procedure and surgery in patients with hypertension (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.07-1.53). When no psoriasis served as a reference group, the aHRs were higher for women than for men, and for patients aged 50-64 years than for younger and older patients. Patients with severe psoriasis or psoriatic arthritis tended to have higher risks of cardiovascular procedure and surgery than patients with mild psoriasis (aHR, 1.22; 95% CI, 0.98-1.51) or patients without psoriatic arthritis (aHR, 1.15; 95% CI, 0.84-1.58), respectively, did, although not reaching statistical significance. In conclusion, patients with hypertension and psoriasis had a greater requirement for cardiovascular interventions than hypertensive patients without psoriasis. More intense assessments for cardiovascular interventions may be necessary in patients with concurrent hypertension and psoriasis than general hypertension patients.
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Affiliation(s)
- Hsien-Yi Chiu
- Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.,Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.,Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wei-Lun Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Neng Shiu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.,Faculty of Pharmacy, National Yang-Ming University, Taipei, Taiwan
| | - Weng-Foung Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Haroon M, Szentpetery A, Dodd JD, Fitzgerald O. Modifications of Cardiovascular Risk Scores, But Not Standard Risk Scores, Improve Identification of Asymptomatic Coronary Artery Disease in Psoriatic Arthritis. J Rheumatol 2018; 45:1329-1330. [PMID: 30173181 DOI: 10.3899/jrheum.180299] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Muhammad Haroon
- Division of Rheumatology, Department of Medicine, University Hospital Kerry, Tralee, and Clinical Senior Lecturer, University College Cork, Cork;
| | - Agnes Szentpetery
- Department of Rheumatology, St. Vincent's University Hospital, Dublin
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Dublin
| | - Oliver Fitzgerald
- Department of Rheumatology, St. Vincent's University Hospital, Dublin, Ireland
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Liu J, Shen P, Ma X, Yu X, Ni L, Hao X, Wang W, Chen N. White blood cell count and the incidence of hyperuricemia: insights from a community-based study. Front Med 2018; 13:741-746. [PMID: 29936636 DOI: 10.1007/s11684-017-0579-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/31/2017] [Indexed: 02/04/2023]
Abstract
Hyperuricemia (HUA) is a risk factor for chronic kidney disease (CKD). The relationship between HUA and white blood cell (WBC) count remains unknown. A sampling survey for CKD was conducted in Sanlin community in 2012 and 2014. CKD was defined as proteinuria in at least the microalbuminuric stage or an estimated GFR of 60 mL/(min∙1.73 m2). HUA was defined as serum uric acid > 420 μmol/L in men and > 360 μmol/L in women. This study included 1024 participants. The prevalence of HUA was 17.77%. Patients with HUA were more likely to have higher levels of WBC count, which was positively associated with HUA prevalence. This association was also observed in participants without CKD, diabetes mellitus, hyperlipidemia, or obesity. Multivariate logistic regression analysis showed that WBC count was independently associated with the risk for HUA in male and female participants. Compared with participants without HUA, inflammatory factors such as high-sensitivity C-reactive protein, tumor necrosis factor-α, and interleukin 6 increased in participants with HUA. Hence, WBC count is positively associated with HUA, and this association is independent of conventional risk factors for CKD.
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Affiliation(s)
- Jian Liu
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Pingyan Shen
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaobo Ma
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xialian Yu
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Liyan Ni
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xu Hao
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weiming Wang
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China. .,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.,Institute of Nephrology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
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Schoels MM, Landesmann U, Alasti F, Baker D, Smolen JS, Aletaha D. Early response to therapy predicts 6-month and 1-year disease activity outcomes in psoriatic arthritis patients. Rheumatology (Oxford) 2018; 57:969-976. [PMID: 29481661 DOI: 10.1093/rheumatology/key004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Indexed: 11/12/2022] Open
Abstract
Objectives In PsA management, remission and low disease activity represent preferential treatment targets. We aimed at evaluating the predictive value and clinical use of initial therapeutic response for subsequent achievement of these targets. Methods Based on data of 216 patients enrolled in a randomized controlled trial of golimumab (GO-REVEAL), we performed diagnostic testing analyses using 3- and 6-month disease activity as tests for treatment outcomes to understand the implications of early response. In regression analyses, we estimated the probabilities for achieving at least LDA. Disease activity was measured by the disease activity index for PsA (DAPSA). Results Three-month DAPSA levels were excellent tests for disease activity at 6 months (and at 1 year), with areas under the receiver operating characteristic curves of 0.92 (and 0.88, respectively). The estimated probability for 6-month LDA could be quantified as <22% if patients did not reach at least moderate disease activity after 3 months on golimumab. Similar data were seen for early DAPSA response: patients achieving a DAPSA 85% at 3 months had an 84% probability for 6-month LDA or REM. All results were validated in an independent trial cohort of patients treated with infliximab (IMPACT 2). Conclusion Three months after implementation of therapy in PsA, it is already possible to evaluate the potential for accomplishing therapeutic goals. This substantiates the choice of the 3-month assessment as essential for treatment adaptations.
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Affiliation(s)
- Monika M Schoels
- Second Department of Internal Medicine, Hietzing Hospital, Vienna, Austria
| | - Uriel Landesmann
- Department of Rheumatology, Medical University of Vienna, Austria
| | - Farideh Alasti
- Department of Rheumatology, Medical University of Vienna, Austria
| | - Daniel Baker
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Josef S Smolen
- Second Department of Internal Medicine, Hietzing Hospital, Vienna, Austria.,Department of Rheumatology, Medical University of Vienna, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Austria
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41
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Legge A, Hanly JG. Managing premature atherosclerosis in patients with chronic inflammatory diseases. CMAJ 2018; 190:E430-E439. [PMID: 29632038 PMCID: PMC5893318 DOI: 10.1503/cmaj.170776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Alexandra Legge
- Department of Medicine (Legge); Division of Rheumatology, Department of Medicine, and Department of Pathology (Hanly), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - John G Hanly
- Department of Medicine (Legge); Division of Rheumatology, Department of Medicine, and Department of Pathology (Hanly), Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, NS
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Egeberg A, Skov L, Hansen PR, Gislason GH, Wu JJ, Thyssen JP, Mallbris L. Duration of psoriatic arthritis as a risk factor for myocardial infarction. Rheumatol Adv Pract 2018; 2:rky011. [PMID: 31431960 PMCID: PMC6649987 DOI: 10.1093/rap/rky011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/04/2018] [Indexed: 01/20/2023] Open
Abstract
Objectives The aim was to examine the association between disease duration and risk of myocardial infarction (MI) in patients with PsA. Methods We used nationwide registry data from Denmark to estimate incidence rates per 1000 person-years and the risk of MI [adjusted hazard ratios (HRs) with 95% CIs] in rheumatologist-diagnosed patients with PsA using Cox regression models. The study period was between 1 January 2008 and 31 December 2012. Results The study population comprised a total of 8071 patients with PsA and 4 348 857 general population control subjects. A total of 156 and 54 215 MIs occurred during follow-up among patients with PsA and the reference population, respectively. There was a significant association between the duration of PsA and risk of MI (adjusted HR = 1.02; 95% CI: 1.01, 1.03 for each additional year after PsA diagnosis). Stratified based on short (<2 years) and long (≥2 years) disease duration, the adjusted HRs were 0.96 (95% CI: 0.60, 1.52; P = 0.8487) and 1.29 (95% CI: 1.09, 1.53; P = 0.0026), respectively. Other significant predictors included age, sex, socio-economic status, smoking, alcohol abuse, diabetes, hypertension and previous cardiovascular disease. Conclusions We observed an increased risk of MI associated with longer duration of PsA. Our findings call for increased focus on disease duration in the cardiovascular risk assessment among patients with PsA.
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Affiliation(s)
| | - Lone Skov
- Department of Dermatology and Allergy
| | - Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jashin J Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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Moltó A, Nikiphorou E. Comorbidities in Spondyloarthritis. Front Med (Lausanne) 2018; 5:62. [PMID: 29594122 PMCID: PMC5857562 DOI: 10.3389/fmed.2018.00062] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 02/20/2018] [Indexed: 12/18/2022] Open
Abstract
Comorbidities in spondyloarthritis (SpA) add to the burden of disease by contributing to disease activity, functional and work disability, and mortality. Thus, awareness of comorbidities in SpA is crucial to improve their screening and management and to ultimately improve outcomes in those affected. Osteoporosis has been reported to be the most prevalent comorbidity in SpA, and its risk is increased in these patients, compared with the general population; the risk of vertebral fractures requires further evaluation. Cardiovascular risk is also increased in this population, both due to an increase of the traditional cardiovascular risk factors in these patients, but also due to the presence of inflammation. The role of non-steroidal anti-inflammatory drugs in this increased risk needs further elucidation, but there is consensus on the need to encourage smoking cessation and to perform periodic evaluation of cardiovascular risk in these patients, particularly in the case of change in treatment course. Concerning the risk of cancer, no increased risk inherent to SpA seems to exist. However, an increased neoplastic risk can occur due to SpA treatments, e.g., P-UVA. Data are sparse on the risk of infections compared with rheumatoid arthritis, but there appears to be no risk in the absence of TNF-inhibitor exposure. Regardless of which comorbidity, a gap exists between recommendations for their management and actual implementation in clinical practice, suggesting that there is still a need for improvement in this area. Systematic screening for these comorbidities should improve both short- and long-term outcomes in SpA patients.
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Affiliation(s)
- Anna Moltó
- Rheumatology B Department, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM (U1153) PRES Sorbonne Paris-Cité, Paris, France
| | - Elena Nikiphorou
- Academic Rheumatology Department, King's College London, London, United Kingdom.,Department of Rheumatology, Whittington Hospital, London, United Kingdom
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Szentpetery A, Healy GM, Brady D, Haroon M, Gallagher P, Redmond CE, Fleming H, Duignan J, Dodd JD, FitzGerald O. Higher Coronary Plaque Burden in Psoriatic Arthritis Is Independent of Metabolic Syndrome and Associated With Underlying Disease Severity. Arthritis Rheumatol 2018; 70:396-407. [DOI: 10.1002/art.40389] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 11/16/2017] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | | | | | | | - John Duignan
- St. Vincent's University Hospital; Dublin Ireland
| | | | - Oliver FitzGerald
- St. Vincent's University Hospital and Conway Institute for Biomolecular Research; University College Dublin; Dublin Ireland
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Eder L, Harvey P, Chandran V, Rosen CF, Dutz J, Elder JT, Rahman P, Ritchlin CT, Rohekar S, Hayday R, Barac S, Feld J, Zisman D, Gladman DD. Gaps in Diagnosis and Treatment of Cardiovascular Risk Factors in Patients with Psoriatic Disease: An International Multicenter Study. J Rheumatol 2018; 45:378-384. [PMID: 29419462 DOI: 10.3899/jrheum.170379] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We aimed to estimate the proportion of underdiagnosis and undertreatment of cardiovascular risk factors (CVRF) in an international multicenter cohort of patients with psoriasis and psoriatic arthritis (PsA). METHODS A cross-sectional analysis was conducted of patients with psoriatic disease from the International Psoriasis and Arthritis Research Team cohort. The presence of modifiable CVRF [diabetes, hypertension (HTN), dyslipidemia, smoking, elevated body mass index, and central obesity] and the use of appropriate therapies for HTN and dyslipidemia were determined. The 10-year CV risk was calculated according to the Framingham Risk Score. Physician adherence with guidelines for the treatment of dyslipidemia and HTN was assessed. Regression analysis was used to assess predictors of undertreatment of HTN and dyslipidemia. RESULTS A total of 2254 patients (58.9% PsA, 41.1% psoriasis) from 8 centers in Canada, the United States, and Israel were included. Their mean age was 52 ± 13.8 years and 53% were men. Of the patients, 87.6% had at least 1 modifiable CVRF, 45.1% had HTN, 49.4% dyslipidemia, 13.3% diabetes, 75.3% were overweight or obese, 54.3% central obesity, and 17.3% were current smokers. We found 59.2% of patients with HTN and 65.6% of patients with dyslipidemia were undertreated. Undertreatment was associated with younger age (≤ 50 yrs), having psoriasis, and male sex. CONCLUSION In real-world settings, a large proportion of patients with psoriasis and PsA were underdiagnosed and undertreated for HTN and dyslipidemia. Strategies to improve the management of CVRF in psoriatic patients are warranted.
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Affiliation(s)
- Lihi Eder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel. .,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital.
| | - Paula Harvey
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Vinod Chandran
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Cheryl F Rosen
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Jan Dutz
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - James T Elder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Proton Rahman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Christopher T Ritchlin
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Sherry Rohekar
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Richard Hayday
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Snezana Barac
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Joy Feld
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Devy Zisman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
| | - Dafna D Gladman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; Division of Dermatology, University of Toronto, Toronto Western Hospital, Toronto; Western University, London, Ontario; University of British Columbia, Vancouver, British Columbia; Memorial University of Newfoundland, St. John's, Newfoundland; University of Manitoba; Winnipeg Clinic, Winnipeg, Manitoba, Canada; University of Michigan Medical School, Ann Arbor, Michigan; Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center, Rochester, New York, USA; Rheumatology Unit, Carmel Medical Center, Haifa, Israel.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; P. Harvey, BMBS, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; C.F. Rosen, MD, FRCPC, Department of Medicine, University of Toronto, and Division of Dermatology, University of Toronto, Toronto Western Hospital; J. Dutz, MD, FRCPC, University of British Columbia; J.T. Elder, MD, PhD, University of Michigan Medical School; P. Rahman, MD, MSc, FRCPC, Memorial University of Newfoundland; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; S. Rohekar, MD, FRCPC, Western University; R. Hayday, MD, FRCPC, University of Manitoba; S. Barac, MD, FRCPC, Winnipeg Clinic; J. Feld, MD, Rheumatology Unit, Carmel Medical Center; D. Zisman, MD, Rheumatology Unit, Carmel Medical Center; D.D. Gladman, MD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital
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Cardiometabolic Comorbidities in Psoriasis and Psoriatic Arthritis. Int J Mol Sci 2017; 19:ijms19010058. [PMID: 29295598 PMCID: PMC5796008 DOI: 10.3390/ijms19010058] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/19/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023] Open
Abstract
There is solid epidemiologic evidence linking psoriasis and psoriatic arthritis (PsA) to cardiovascular risk factors and an increased risk of developing cardiovascular disease. Chronic inflammation, with shared pathways and cytokines common to metabolic syndrome, atherosclerosis and psoriasis, might provide the basis for the cardiovascular and metabolic comorbidities of psoriasis and PsA. The purpose of this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of cardiovascular risk factors and cardiovascular disease in patients with psoriasis and/or PsA; the use of analytical determinations, physiologic measures and imaging techniques as surrogate biomarkers of atherosclerosis, endothelial dysfunction and cardiovascular disease in these patients; and the epidemiological and clinical data, including results of clinical trials, supporting a cardioprotective role of anti-inflammatory and disease-modifying treatment in psoriasis and PsA.
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Eder L, Harvey P. Cardiovascular Morbidity in Psoriatic Arthritis: What Is the Effect of Inflammation? J Rheumatol 2017; 44:1295-1297. [PMID: 28864663 DOI: 10.3899/jrheum.170534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Paula Harvey
- Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW Patients with psoriasis and psoriatic arthritis, collectively termed psoriatic disease (PsD), are at an increased risk of developing cardiovascular diseases (CVD). The purpose if this manuscript is to review recent evidence about the epidemiology and underlying mechanisms of CVD in psoriatic patients and approaches to improve the management of these comorbidities. RECENT FINDINGS Studies have shown that CVD risk is independent of traditional cardiovascular risk factors and is related to the systemic inflammatory nature of PsD. The use of surrogate markers, such as imaging of subclinical atherosclerosis, allows detection of patients at high cardiovascular risk before the occurrence of clinical events. These modalities could be clinically useful as clinical cardiovascular risk algorithms, such as the Framingham Risk Score, and have been shown to underestimate the actual cardiovascular risk in patients with PsD. Additional challenges related to the management of CVD in psoriatic patients include the underdiagnosis and undertreatment of traditional cardiovascular risk factors in rheumatology, dermatology and primary care setting. Effective measures used to control PsD, such as tumour necrosis factor inhibitors and methotrexate, has been associated with reduced cardiovascular risk in psoriatic patients. These findings highlight the importance of controlling disease activity as potential target that could lead to reduced cardiovascular risk. Together this highlights the importance of optimization of cardiovascular risk stratification and management of cardiovascular risk factors in patients with PsD.
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Affiliation(s)
- Curtis Sobchak
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lihi Eder
- Division of Rheumatology, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Abstract
Epidemiological studies have shown that patients with psoriatic arthritis (PsA) are often affected by numerous comorbidities that carry significant morbidity and mortality. Reported comorbidities include diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases, osteoporosis, inflammatory bowel disease, autoimmune eye disease, non-alcoholic fatty liver disease, depression, and fibromyalgia. All health care providers for patients with PsA should recognize and monitor those comorbidities, as well as understand their effect on patient management to ensure an optimal clinical outcome.
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Affiliation(s)
- Amir Haddad
- Rheumatology Unit, Carmel Medical Centre, Haifa, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Centre, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
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Dessein PH, Solomon A, Hollan I. Metabolic abnormalities in patients with inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:901-915. [DOI: 10.1016/j.berh.2016.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
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